Like many people in my demographic slot (female, near retirement age), I have become a keen, if reluctant observer of medical culture in America. Not only do I deal with my own three medicine men (one of whom is a woman), but, for the past seven years, I have tangoed with more than a dozen doctors treating my parents' various ailments.

I have filled out medical history forms for my parents in four different counties, stood beside them in examining rooms, er cubicles, and intensive care units, signed consent forms, and watched monitors record their test data. The experience has caused me to ponder any number of questions, not least of which is, how do we hold together our parts when they have been divvied up among various specialists? Or simply when, without medical assistance, they begin to shut down on their own and there is less and less of us.

For several decades, Dr. S has been my parents' general practitioner (now known as a PCP or "primary care physician"). An Ethiopian immigrant with grizzled white hair and gold-rimmed glasses, Dr. S, like most PCPs today, mainly treats colds and flu and minor infections. His wife serves as receptionist. The waiting room is always crowded, mostly with Medicare and Medicaid patients. His examining room is piled with tattered trade journals, freebies from pharmaceutical companies, and half-used cartons of supplies.

Dr. S mostly acts as a referral agent to specialists, each of whom gets only a piece of my parent to work with. Like butchering diagrams in cookbooks, only more complicated, the body is divvied up among various specialisties, all as adamant about their boundaries as Balkan nationalists. My mother's neurologists got her brain. The orthopedist got her bones and the dermatologist her skin. My father's cardiologist worked on his heart, the urologist on his prostate gland.

So focused was each specialist on his particular cut that none ever inquired about problems in other jurisdictions. Unless I insisted, few bothered to check whether the medications they prescribed might conflict with those ordered by other doctors. Physicians these days are bred to be isolationists but are working in the global economy of the body.

"Holistic" health that, just a decade or so ago, seemed to promise a shift toward treating "the whole person" has been sidelined as discoveries in genetics and electronic imaging of various sorts have captured our fascinated attention. By chopping up microscopic strings of DNA, we can now be divided into ever finer molecular portions.

Several years ago I spent the summer driving my mother to a hi-tech diagnostic center 75 miles away where diagnosticians searched for the cause of her increasing pain and physical difficulties. But none of the printouts from the often arduous tests revealed an answer.

Then a young neurologist, just revving up his first practice in subleased office space, nailed the problem in five minutes simply by watching my mother walk 20 feet, turn, and touch her nose with her index finger.

"Parkinson's Disease," he said. Both my mother and I sighed with relief. At least we knew what we were up against. I could have kissed his tasseled loafers.

But despite his skill as a diagnostician, Dr. P practices medicine the way a whiz-kid stockbroker deals in futures —fast and pumped. He enters the examining room still pocketing his cell phone. "How are you today?" he opens, scribbling away on his clipboard.

"That's what you're supposed to tell me," my mother says, half joking, half miffed by his lack of manners.

I smile. He doesn't.

"She's been taking the larger dose of Sinemet because she's felt weaker," I say. When he looks blank, I add, "Remember? You cut the dosage in half last time."

"I did?" He flips several pages back and forth on the clipboard. "Are you sure?"

"Yes," my mother puts in. She is sitting in the tiny room's only chair. She leans forward now, her hands clasped so tightly in her lap her knuckles are white.

"Can you tell any difference?" he asks.

"I don't think so," my mother says.

"But you said you didn't have the strength to do anything, Mother. So you went back to the larger dosage."

The doctor taps his clipboard with his pen, his eyes darting from me to her.

My mother looks confused now. Everything is going too fast for her to follow.

Dr. P has her climb onto the examining table and roll up her sleeve. He pumps up the armband and listens through the stethoscope, his face trained to immobility. When she asks a question, he jerks his earpiece away, frowning. "Just a minute."

We all watch the red line slowly drop on the meter. "Perfect," he says. "One fifteen over seventy. Textbook."

He scribbles a new script for Sinemet—the large dose—and shoves it at me, along with the usual invoice to turn in at the appointments desk. "See you in two months."

I look at my watch. Five minutes flat.

Parkinson's patients, because of the slower operating speed of their neurological network, need time—to move, to think, to speak. If they're rushed, the signals between their muscles and their mind tangle in a useless snarl, producing the characteristic tremor. Five minutes may have been long enough for Dr. P to diagnose my mother's symptoms, but it is not long enough to treat her.

When my father began to complain of chest pains, Dr. S referred us to a cardiologist in a town 60 miles

away. There, we entered another, more elegant world of medicine. We sat in the mauve and forest-green waiting room, listening to muted Chopin on a state-of-the-art sound system. I can gauge how important my father considers an occasion by whether or not he chooses to wear his dentures.

He has them in today. My father is no clotheshorse. Except on Sunday, he wears what I call his "romper suits," one-piece zippered coveralls. But today he wears slacks and a sport coat, though they don't exactly match. He holds the gray felt Stetson which my mother bought him several Christmases ago. All this, I realize, is to give him a certain gravitas with the doctor.

My father moves his shoulders around inside his jacket, stretching his neck forward, pinching the skin over his Adam's apple. He has written out—painfully, for he is not a writing man ordinarily—a brief narrative of his heart problems, starting with his first catherization and progressing to recent "episodes" he's been having. Unfortunately, he has left this account at home. He has, however, remembered to bring the list of medications he's currently taking and a set of unwieldy X-rays from that 15-year-old catherization.

At last Dr. L arrives, slipping his cell phone from his ear and into his pocket as he opens the door. Tall, olive-skinned, he introduces himself with an accent I can't quite place but somehow imagine is Portuguese.

After my father unbuttons his shirt, Dr. L tries to pull up the T-shirt to listen to his heart, but the T-shirt won't budge. "What is this?" Dr. L frowns.

My father has, as usual, hooked the T-shirt to his boxer shorts with a safety-pin. "It's to keep my britches from falling down around my ankles," he splutters through his unwieldy teeth.

Dr. L cocks an eyebrow. "Better you should use a pin than you should be fat," he says.

After making the usual transit around the chest with the stethoscope, he glances at me. "He appears fine. What seems to be the problem?"

My father puts one hand behind his ear, a signal to repeat.

The doctor turns back to him. "Why have you come to me today?" he says louder, then looks at me again.

Bereft of the chronological narrative he has left at home, my father begins to recount irrelevant and confusing information which tumbles out in no particular order. I hand over the list of medications and the 15-year-old x-rays. The doctor studies them, frowning.

"The blockage here," he points to several spidery lines, "60 to 70 percent. Borderline. When it gets up to 75, then we start to think of doing something. We start slow, okay? The conservative approach. Maybe a cardiolite test first. It will give to me the information I need before a more invasive procedure. Okay?" He looks at me. "Your father's age. You understand?"

He turns back to my father, who is carefully repinning his boxer shorts to his undershirt, and gives him the usual lecture about cholesterol, how lowering it can reduce his chance of heart attack, even at 80, by 50 percent.

I follow Dr. L to the reception desk where he schedules a stress test for my father two weeks hence, the earliest slot they have open.

My father joins us, dressed now, and rotating the Stetson in his jerky fingers. We all shake hands again. After the two of us are back in the car, I repeat for my father, with an interpretive gloss, all the doctor has told me. He nods, a little disappointed, I think, that the doctor hadn't sent him straight to the hospital for bypass surgery. His buddies at church compare their scars, recovery times, numbers of arteries rerouted. My father, without such war stories to tell, feels like a kid who didn't make the cut for the team.

His stress test two weeks later, however, supplies him with plenty of material. He has undergone the ritual cleansing by fasting—even from water—for 12 hours before we show up at the lab. My father climbs onto a long, padded table and lies on his back, his little pot belly rising slightly above his sparsely haired chest. A technician tapes his right arm to his side, his left arm across his forehead. A half-hour earlier he was injected with a chloride solution whose molecules are tagged with a radioactive isotope that now makes his liver glow green on the monitor screen. When the technician sees that the tagged drug is beginning to move into his bloodstream, a disk about the size of a small satellite dish starts to slowly circle my father's chest. A camera captures and stores the glowing images of his heart at set intervals.

Meanwhile, I sit in the waiting room, leafing through a coffee-table book titled From the Heart: Its History, Its Symbolism, Its Iconography and Its Diseases. The heart, I learn, was the only organ the Egyptians left in the body cavity when they embalmed their dead. This organ had to outweigh an ostrich feather if its owner were to be judged worthy of joining Osiris in the afterlife. The Egyptians—along with the Sumerians, Greeks, Hindus, Chinese, and ancient Hebrews—believed the heart to be the seat of the soul. At least until Hippocrates came along and changed its location to the head.

I turn the page and see a color reproduction of the Sacred Heart of Jesus, dripping blood. Adoration of the Sacred Heart, I read, began during the 12th century, encouraged by Bernard of Clairvaux, Mechtilde de Magdebourg, Gertrude the Great, and St. Bonaventure among others. Four hundred years later, Saint Teresa of Avila reported that an angel had pierced her heart with a golden arrow. When she died, her convent put her heart in a heart-shaped crystal urn and preserved it in alcohol. The book reports that a cardiologist has examined the heart and declares that he indeed found a tear or split in the myocardium of its left ventricle.

Radioactive isotopes, angelic golden arrows—take your pick. Neither can be perceived by the naked eye of ordinary mortals. It takes a saint or a medicine man to read such ineffable signs.

After the test, as he traced the silted passageways of my father's coronary arteries on the display screen, Dr. L told us that two arteries were 100 percent blocked, a third 99 percent, and a fourth 90 percent. Given such convincing numbers, we decided to take Dr. L's recommendation to skip angioplasty and go directly to bypass surgery.

At 6 A.M. the following Monday, we were at the hospital. Despite the early hour, my father, the cardiologist, and the heart surgeon spoke in sports metaphors and clapped one another on the back after each huddle. Later, on the recovery ward, the nurses became the cheerleaders, urging my father forward on his recuperative treks down the hall, encouraging his appetite, applauding his bowel movements. My father left the hospital feeling he'd won the championship. And, like a sports hero, he reveled in replaying the game for all his visitors.

Is the heart or the head the soul's container? Dr. L's coffee-table book had reminded me that it was the heart the ancient Aztecs ripped from their sacrificial victims as an offering to the gods. The Egyptians thought so little of the pulpy brain that they threw it away when they embalmed a body. It was the heart they weighed against the ostrich feather.

In this century, however, the heart is merely a pump, an interchangeable component like a plug-and-play computer peripheral. But the head is an area still fraught with uncertainties. We can medicate it, but we don't yet do brain transplants. Maps of the brain have improved vastly over the last 20 years, but they don't come close to telling us as much as my father's cardiolite pictures. Nor are their flaws as easily fixed. The cardiologist was a lot prouder of his success with my father's heart than my mother's neurologist was of my mother's deteriorating brain.

When I first started the long, slow minuet with my mother's medicine men, I was anxious about usurping her prerogatives. I wanted her doctors to speak directly to her. I tried to stay in the background, supplying information when it was needed, taking note of instructions the doctors gave her. I wanted, in other words, for her to be treated like a person and not the mere object of scientific inquiry.

I made sure my mother sat right under the doctor's nose and, when he asked me a question, I took pains to redirect it to her. If I was insistent and sufficiently unsubtle, the doctor usually got the point and made an effort to play along, at least at the beginning. But it didn't take long for him to grow frustrated.

Sometimes my mother had a hard time understanding a question and was slow to respond. Sometimes she just looked helplessly at me, unable to frame a reply. Once she simply shrugged and said with unmistakable bitterness, nodding toward me, "Ask her." Sometimes her replies simply sounded irrelevant. Then the doctor frowned and turned back to me. Thus, I became an accomplice to these doctors in the objectification of my mother.

I understood the doctor's frustration. He was working with a woman who either couldn't or wouldn't reveal her secrets, a woman who saw him as the enemy.

After these exams, I recapitulated the visit, hoping it would help her remember his instructions. I explained again any new information about her condition. But she wasn't fooled. She knew she was the bug under the microscope.

So I also understood my mother's disengagement from her own treatment. I sympathized with her reluctance to cooperate, even as it angered me. What was the point of these visits, after all, if the doctors ultimately could do nothing for her?

My father, a lifetime consumer of fat in any form, recovered from his triple-bypass surgery, according to Dr. L, "like a 40-year-old."

Unlike my father, my mother had always been scrupulous about her diet and kept her cholesterol under control. She did not smoke or drink. She exercised daily. She brushed and flossed diligently. Yet she spent the last five years of her life in a nursing home, gradually sinking into immobility, aphasia, and dementia.

Mine is a cautionary tale, but not one meant to demonize doctors. None of my parents' dozen doctors were slipshod in their specialties. My father would probably be dead by now were it not for Dr. L's perspicacity. As for young Dr. P, neither he nor my mother's subsequent neurologist could have cured my mother's disease or halted her brain's degeneration.

Dr. S, her PCP, called in renewals whenever her prescriptions ran out, but none of her doctors visited her after she entered the nursing home. Looked at from their perspective, this was only reasonable. There was nothing more to be done.

But these kinds of decisions, automatic and embedded into our culture, affect more than the old and ill. They shape our cultural understanding of what constitutes a human person.

Did that malfunctioning bit of tissue, no more than the size of a walnut, in the middle of my mother's brain disqualify her for personhood? What part of your body can you afford to lose if you want to still be taken seriously, not only by the medical profession, but by your healthy fellow citizens?

A small wooden box sits on a table in the vestibule of my church. Into this box, people slip folded bits of paper. The notes contain prayer requests, most often for the healing of a friend or family member.

A group of women at my church have dedicated themselves to praying daily for these people. It's a very low-tech operation. Some of the requests are specific, some are only names. For each, we ask that God "comfort and relieve them in body, mind, and spirit," knowing how distress in one category affects the others.

Do our intercessions help these people, some of whom are only names to us? We are pleased, of course, when we hear that life has improved for one of our prayer customers. But some we never hear of again. Intercession is not an occupation that lends itself to calculable results. But then—witness the paradoxical outcomes of my parents' health habits—medicine is not exactly or entirely measurable either.

I admit that I sometimes sigh at the absurdity of mouthing the names that mean nothing to me. I don't know if it profited my mother when the women prayed for her. I do know, however, that it helped me when I remembered that her name was on their lips. Not all of them knew my mother. But even their prayers were a recognition that she had a name, that she still mattered.

Virginia Stem Owens is the author most recently of Living Next Door to the Death House (Eerdmans), written with her husband, David Clinton Owens.

Copyright © 2004 by the author or Christianity Today/Books & Culture magazine.
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